n the early stages
there is retention of urine and constipation; later the bladder and
rectum are paralysed, and there is incontinence.

Sudden death may result when dislocation of the atlo-axoid joint takes
place.

Cervical caries has to be diagnosed from rheumatic torticollis, and
from the effects of injuries, such as a sprain or twist of the spine.
When a retro-pharyngeal abscess points behind the sterno-mastoid, it
is apt to be mistaken for a cold abscess originating in tuberculous
cervical glands. Retro-pharyngeal abscess due to other causes is
described with diseases of the pharynx.

_Treatment._--Extension is applied to the head, preferably by means of
an elastic band fixed to the top of the bed, and the head of the bed
is raised on blocks so that the weight of the body may furnish the
necessary counter-extension. Lateral movements of the head are
prevented by means of sand-bags. After the acute symptoms have
subsided, the spine should be fixed by some rigid apparatus, such as a
double Thomas' splint prolonged so as to support the occiput (Fig.
215).

[Illustration: FIG. 215.--Thomas' Double Splint for Tuberculous
disease of Spine.]

When it is considered advisable to open a retro-pharyngeal abscess,
this should be done from the side of the neck by an incision along the
posterior border of the sterno-mastoid, as first recommended by John
Chiene. The abscess is evacuated, and the cavity filled with iodoform
emulsion, and closed without drainage. An opening made through the
mouth is attended with the risks of pus being inhaled into the
air-passages and of pyogenic infection.

When the patient is allowed to get up, a poroplastic collar and jacket
of the Minerva type which supports the head and controls the movement
of the cervical and thoracic vertebrae must be worn until the cure is
complete.

#Cervico-thoracic Region.#--When the lower cervical and upper thoracic
vertebrae are affected, in addition to the fixed pain in the diseased
bones, the patient complains of pain radiating along the distribution
of the superficial cervical nerves and down the arms. There is often
marked angular deformity. If an abscess forms, it may come to the
surface in the lower part of the posterior triangle, or may spread
into the posterior mediastinum or into the axilla. Sometimes the pus
burrows behind the oesophagus and trachea, and it may find its way
into the pleural cavity. The cord is not often pressed upon; when it
is,